Periodontal disease and diabetesWhat is periodontal disease?Periodontal disease is the scientific name used to describe gum disease. There aretwo common forms of periodontal disease. The first is called gingivitis, which is mildinflammation of the gums. The other, more serious, form of gum disease is calledperiodontitis, in which there is more severe inflammation of the gums, and the bonethat holds the teeth in place begins to be gradually destroyed.Recognizing whether you have periodontal diseaseThe most certain way to find out if you have periodontal disease is to visit a dentist. Ifthe dentist suspects that you may have periodontal disease, x-rays of your teeth may be taken to check the health of the bonethat holds the teeth in place.Healthy gums are pink and firm, are tightly attached to the teeth, and don’t usually bleed when you brush your teeth (Figure1). Gingivitis develops when the teeth arenot brushed effectively. Plaque builds up on the teeth, next to the gum, and the bacteria in plaque cause the gums to becomeinflamed. As a result, the gums look inflamed and swollen (Figure 2), and may bleed when you brush your teeth. Gingivitis istotally reversible, and with good oral hygiene the gums can return to normal.Periodontitis, the more serious form of gum disease, results from prolonged (overseveral years) inflammation of the gums as a result of long-term plaque accumulation.The gum inflammation becomes more and more severe (Figure 3), and the gums start to detach from the tooth. This cre-ates a space between the gum and the tooth called a ‘pocket’ which is measured by the dentist with a probe. As the pocketgets deeper, the jaw bone holding the teeth in place is gradually destroyed. This process is typically painless, and it progressesvery slowly. After many years, so much bone may have been destroyed that the tooth starts to become mobile or loose andgums begin to recede,making the teeth look longer than they used to. This may be the first indication to some patients that there is a problem.What has periodontal disease got to do with diabetes?In people with diabetes there is an increased incidence of periodontal disease.We still don’t know the precise reasons why people with diabetes are more likely to suffer from periodontal disease, and this isan ongoing area of research. There are probably several factors which are important, including:•• the immune system may not function properly in people with diabetes, thereby increasing the risk of periodontal disease excess lipid tissue (body fat) in obese people with diabetes may produce chemicals which make the gums more likely to become inflamed• damage to capillaries (the small delicate blood vessels) in the gums may reduce the blood supply to the gums, thereby limiting the actions of defense cells• wound healing is impaired in diabetes, and therefore, healing in the gums is also reduced. Figure 1 Healthy gums are Figure 2 Gingivitis: inflamed Figure 3 Periodontitis: the Figure 4 Using a single tufted pink and firmly attached to gums that look red and swollen gums are very inflamed, toothbrush to clean an awkward the tooth. (particularly the part of gum next red and swollen. There is area with slightly overlapping to the tooth), and may bleed on bleeding from the gums, and the teeth. The brush is cleaning the brushing. gums around the lower teeth point where the gum meets the are receding. tooth.
symPtomsThe key thing to remember is that glycemic control (blood sugar level) seems to be very important indetermining susceptibility to periodontal disease. Research suggests that individuals with good diabetescontrol A1C < 7 have a reduced risk of periodontal disease compared to individuals with an A1C > 8.5.What is the treatment for periodontal disease?As with most diseases, prevention is better than a cure. Periodontal disease can generally be preventedby maintaining good oral hygiene (i.e. cleaning your teeth effectively).Brush your teeth twice per day, for approximately 2-3 minutes each time (which is longer than youthink when brushing your teeth!). Be sure to brush every surface of the teeth, and particularly the pointwhere the gum meets the tooth (Figure 4). If your teeth are a little overlapping, or there are awkwardareas to clean, then use a small (single tufted) brush. The toothbrush should be positioned so the bristles contact the point wherethe gum meets the tooth at about a 45 degree angle. Use short back and forth strokes of the brush, with gentle pressure.An electric toothbrush brush for most people is as effective as a manual toothbrush. They can also be useful if you have restrictedmovement. Make sure you clean in between the teeth using floss.If you have problems with gum disease, it isalso recommended to use a mouthwash afterbrushing. Make sure it contains fluoride.Summing upIt is very important for all people with diabetes to visit a dentist regularly, so that Hold flossany gum problems can be detected and treated before they become too severe.Your dentist may also clean your teeth for you on a regular basis, or may ask youto see a dental hygienist for cleaning.People with diabetes are more prone to gum disease, especially if their diabetesis poorly controlled. Good oral hygiene and regular dental check-ups areparticularly important in people with diabetes. Floss between upper teeth Floss between lower teeth
staying healthy until a cure is found.Key points to remember• As someone with diabetes you may be more prone to gum problems. See your dentist regularly.• By keeping good control of your diabetes, and having good blood sugar control, you can reduce the likelihood of gum disease.• Brush and floss your teeth regularly, being careful to brush every part of the tooth. If this makes the gum bleed, it may be a sign of gum inflammation. If you are concerned about bleeding gums, be sure to visit a dentist.• Even if you no longer have your own teeth, you should still see a dentist periodically to check the health of your mouth.• If you have had periodontal disease in the past, it is especially important to continue to see the dentist to make sure the disease does not recur.• Don’t smoke. Smoking makes gum disease worse. All rights reserved. 5151 Wisconsin Ave. NW, Suite 420 • Washington, D.C. 20016 www.diabeteswellness.net Helpline Questions 1-800-941-4635 • Administrative offices 202-298-9211 An Organization for People Who Live with Diabetes Every Day. The mission of Diabetes Research & Wellness Foundation (DRWF) is to help find the cure for diabetes, and until that goal is achieved, to provide the care and self-management skills needed to combat the life-threatening complications of this terrible disease. Thank you for your confidence in the programs and services that the Diabetes Research & Wellness Foundation® provides to the community. Please designate us in the Combined Federal Campaign & United Way. Check box #11629.